Access to optimal treatment for HIV in Kazakhstan: as prices go down, so does stigma

MMA’s campaign partner in Kazakhstan, Answer, focuses on reducing prices, and improving access to optimal treatment for HCV, viral hepatitis B (HBV/D) and mainly HIV.  Concerning the latter, besides high drug prices, stigma has been a barrier to HIV services in Kazakhstan.

Access to optimal ARV treatment can create a positive cycle by reducing HIV-related stigma, so more people feel able to access services to prevent and treat HIV.

© Didar Kushamanov/Majority World/Make Medicines Affordable/2021

Nurali, the head of the Central Asian Association of People Living with HIV, and Kristina, who works at the Revansh drop-in centre for people living with HIV and people who use drugs, explain how access to optimal treatment can reduce HIV-related stigma. Older ARVs had serious side effects that led people living with HIV to stop taking it. Newer (and more expensive) drugs have far fewer – and milder – side effects, making it easier for people to treat their HIV.

Nurali, who is 50 years old, is from Almaty, Kazakhstan: “I was diagnosed with HIV in 1998, while I was in prison. Shortly after I was also diagnosed with TB. I weighed about 40 kilograms, I thought I was going to die. It made me reassess my values. Looking back at my life I felt I had done nothing good with it. I decided to stop using drugs when I was released from prison. There was a high level of stigma in 1998. My family accepted me, but everyone was afraid of HIV.”

HIV treatment saved Nurali’s life – but he had to wait 14 years before he was able to access it.

“I started treatment when the state began to provide drugs in 2012. Before that, ARVs were only prescribed for a certain level of CD4 cells. Today I am 50, I have been living with HIV for 22 years, and I am the head of the Central Asian Association of People Living with HIV. I live a healthy life on treatment.”  He believes more people would access prevention and treatment services if stigma was reduced: “Stigma is a key problem in Kazakhstan. Many people do not want to open up. We need more awareness of the facts of HIV among the population. Access to good treatment can reduce self-stigma and provide a positive role model to change the attitude of others.”

Kristina learned about her HIV status in 2012, while she was in prison. Her main worry was how her adult daughter would react.

“For a month-and-a-half I was preparing to tell her about it. She accepted me.”  After facing discrimination at work, Kristina quit her job. “Now I am a social worker in the public fund ‘Revansh’. I needed to help people.”

In 2014, she started HIV treatment, and has had only minor side-effects.

“I am happy with the treatment. I wish that everyone had the same opportunity. There are many undocumented people. They do not receive social benefits. The state doesn’t know about them or their HIV status. We need to make HIV treatment free for everyone, and for people to come forward without stigma or fear.”

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